RT Journal Article
SR Electronic
T1 Care bundle to reduce readmission in patients with heart failure: a modified Delphi consensus panel in Argentina
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e040028
DO 10.1136/bmjopen-2020-040028
VO 10
IS 12
A1 Roberti, Javier
A1 Vita, Tomás
A1 Piastrella, Jimena
A1 Porley, Carlos
A1 Pereyra, Lisandro
A1 Diez, Mirta
A1 Renedo, Florencia
A1 Fairman, Enrique
A1 Fernández, Alberto
A1 Thierer, Jorge
A1 García Elorrio, Ezequiel
YR 2020
UL http://bmjopen.bmj.com/content/10/12/e040028.abstract
AB Objectives The aim of this study was to develop consensus among Argentine cardiologists on a care bundle to reduce readmissions of patients with heart failure (HF).Setting Hospitals and cardiology clinics in Argentina that provide in-hospital care for patients with HF.Participants Twenty-four cardiology experts participated in the two online rounds and 18 (75%) of them participated in the third-round meeting.Methods This study used a mixed-method design; it was conducted between August 2019 and January 2020. The development of a care bundle (a set of evidence-based interventions applied to improve clinical outcomes) involved three phases: (1) a literature review to define the list of interventions to be evaluated; (2) a modified Delphi panel to select interventions for the bundle and (3) definition of the HF care bundle. Also, the process included three rounds of scoring.Results Twenty-six interventions were evaluated. The interventions in the final bundle covered four categories: medication, continuum of care, lifestyle habits, predischarge tests. These were: medication: beta-blockers, angiotensin receptor neprilysin inhibitors or ACE-inhibitors, furosemide and antimineralocorticoids; continuum of care: follow-up appointment, daily weight monitoring; lifestyle habits: smoking cessation counselling and low-sodium diet; predischarge tests: renal function, ionogram, blood pressure control, echocardiogram and determination of decompensating cause.Conclusion Following a systematic mixed-method approach, we have developed a care bundle of interventions that could decrease readmission of patients with HF. The application of this bundle could contribute to scale evidence-based interventions.